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tions and psychiatric experiences, and on data regarding each subject's social adjustment given by a knowledgeable informant." The findings did not reveal any significant difference between the mental health of "acculturated" versus "unacculturated" women, but they did show the following correlation between mental health and numbers of children:
The barren women from both groups have the poorest mental health: the points of optimally good mental health coincide with the women who have 2, 3 or 4 children, and there is again poor mental health in both groups among women with 6 or more children. (50, p. 8)
Finally, from England there are some intriguing data from Pyke's study of the relationship between parity and the incidence of diabetes in women, most of whom were over 45 at the time of onset (51). In a comparison of the number of women in each parity group among the diabetics with that of a control population, the increase in diabetes with increasing parity of the women was dramatic and highly significant statistically, as suggested by Figure 9.
The effects of increasing numbers of pregnancies on mothers must also be mentioned here. A large number of pregnancies is a necessary precondition for a large number of children, although it is obvious that where infant or childhood mortality rates are high, a mother may belong in the "grand multi-para" group and yet have only a few living children. Repeated pregnancies followed by prolonged lactation periods will, among other things, produce sustained needs for high quality protein in the diet. In the many parts of the world where these needs are poorly met, the result is what Jelliffe has termed the "maternal depletion syndrome" (14). This process may contribute to low birth weight of their infants, to poor performance in lactation and, ultimately, ". . . this cumulative process plays a part in the premature ageing and early death often seen among women in developing regions."
Direct evidence concerning this condition is scant, although most clinicians who have worked in such countries would certainly agree with Jelliffe. In direct evidence, however, is available. Wright (52), for example, studied maternal mortality figures for Ceylon during 1962-63 by maternal age group He found that in age groups 35 to 39, 40 to 44, and 45 to 49 the risk oi maternal mortality exceeded the overall average maternal mortality risk b> factors of 1.5, 2.0, and 3.3 respectively. Advancing age per se is undoubted!} operating here, but in a country like Ceylon advancing age and advancing parity are closely connected, and Eastman and Hellman (53) have stated tha the effects of these two factors on increasing maternal risk are additive—eacl increases the risk independently.
Perkin (54) has examined similar data from Thailand that tends to confirn the findings from Ceylon. Among other things, he reported that in 196.